Endoscope and method of use

ABSTRACT

Medical devices and methods related to endoscopic systems suitable for hysterectomy and other purposes.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims benefit of priority to U.S. Provisional Patent Application No. 62/933,081, filed Nov. 8, 2019, the content of which is incorporated herein by reference in its entirety.

BACKGROUND OF THE INVENTION

The present invention relates generally to medical devices and methods. More particularly, the present invention is related to endoscopic systems suitable for hysterectomy and other purposes.

Endoscopic systems of the invention intended for hysterectomy typically comprise a base station having an image display, a disposable endoscope component with an image sensor, a re-usable handle component that is connected to an image processor in the base station, and a fluid management system integrated with the base station and handle component. The endoscope component and the re-useable handle are typically referred to as a hysteroscope.

Of particular interest to the present invention, hysteroscopes and other endoscopes provide for the introduction of interventional tools through a working channel in the shaft of the scope. The size of the working channel of a hysteroscope is limited by the need to introduce at least a distal portion of the shaft through the patient's cervix.

Of further interest to the present invention, hysteroscopes may have a shaft rotatable relative to the handle, and that shaft will often carry a camera and light source that need to be externally connected through the handle.

Of still further interest to the present invention, rotatable hysteroscope shafts may also carry fluids through a lumen which has an external port fixed in the handle.

For these reasons, it would be desirable to provide improved hysteroscopes which can accommodate the introduction of comparatively large tools though a shaft with a relatively low profile. It would be further desirable to provide improved hysteroscopes which can accommodate the connection of cameras, light sources, and the like, on rotatable shafts through stationary handles. It would be still further desirable to provide improved hysteroscopes which can accommodate the flow of fluids through rotatable shafts coupled to stationary handles. At least some of these objectives will be met by the inventions described hereinbelow. However, the methods and devices described herein will include additional benefits as recited by the claims.

Hysteroscopic systems of a type similar to that illustrated herein are described in commonly owned, co-pending application Ser. Nos. 15/712,603; 15/836,460; 15/861,474; and Ser. No. 15/975,626, the full disclosures of which are incorporated herein by reference.

SUMMARY OF THE INVENTION

In a first aspect of the present invention, a hysteroscope or other endoscopic system comprises a shaft having an outer shaft diameter, a distal shaft portion, a proximal shaft portion, and a longitudinal axis therebetween. A handle is coupled to the proximal portion of the shaft, and an image sensor with a diagonal dimension is carried by the distal portion of the shaft. A channel extends through at least the distal shaft portion and has a channel diameter. A section of the channel in the distal portion of the shaft is re-configurable between a constricted shape or geometry and a non-constricted shape or geometry to accommodate a tool introduced there through. Because of the re-configurable nature of the distal portion of the channel, the combined diagonal dimension and channel diameter may be greater than the outer shaft diameter. The handle will typically be detachably coupled to the shaft so that the handle is reusable and the shaft is disposable, but at least some aspects of the present invention will be found in endoscopes comprising fixed handle-shaft structures as well.

In certain exemplary embodiments of the endoscopes of the present invention, the diagonal dimension will be at least 50% of the outer shaft diameter, typically being at least 60%, or greater. In further exemplary embodiments, the channel diameter will also be at least 50% of the outer shaft diameter, more often being at least 60% of the outer shaft diameter, or greater.

In other exemplary embodiments, the endoscopes of the present invention will be provided in systems which further comprise a fluid inflow source for providing fluid flow through an inflow channel in the shaft to an outlet in the distal portion of the shaft. Usually, such systems will further comprise a negative pressure source for providing fluid outflows through the outflow channel in the shaft and an opening in the distal shaft portion. Still further, the systems may comprise a controller for controlling fluid flows through the inflow and outflow channels and at least one actuator in the handle for adjusting fluid inflows and outflows. For example, the controller may be configured with algorithms for operating the fluid inflow source and the negative pressure source to maintain fluid within a set pressure range in a working space, such as the uterine cavity.

In a second aspect of the present invention, a hysteroscope or other endoscope comprises a handle having an interior, an axis, and an electrical connector fixed to the handle. A shaft is removably or otherwise coupled to the handle and configured to rotate, typically reversibly rotate, about a longitudinal axis relative to the handle through an arc of about 180° or greater. An electronic image sensor is carried at a distal end of the shaft, and one or more electrical leads extend from the image sensor to the electrical connector in the handle. The electrical lead(s) are flexible and configured with a “slack” portion in the interior of the handle to accommodate rotation of the shaft. By “slack,” it is meant that the length of the electrical lead(s) is greater than the distance between the electrical connector and the point of attachment of the electrical lead(s) to the shaft so that the shaft may be rotated without over tensioning the electrical lead(s).

In further exemplary embodiments of this endoscope, the slack portion may be formed as any one of a coil, a spiral, a folded structure, a serpentine structure, or the like. In specific embodiments, one end of the slack portion will be coupled to and extend around the axis of the rotating shaft assembly, typically being carried on a spool secured to the shaft assembly. The spool is usually aligned concentric or co-axially with the axis of the shaft so that as the shaft is rotated, the spool may take up or let out the flexible electrical leads as needed. In specific examples, the electrical leads may comprise the flex circuits.

In still further exemplary embodiments of these endoscopes, a light emitter may be carried at the distal end of the shaft and second electrical lead(s) may extend from the light emitter to a second electrical connector fixed in the handle. The second electrical leads are configured with a second slack portion to accommodate rotation of the shaft. The second shaft portion may also be carried on a second spool and may comprise a flex circuit.

In still further aspects of this endoscope, a channel may be formed in the shaft where a portion of the channel is re-configurable between a constricted shape and a non-constricted shape to accommodate introduction to a tool through the channel. As with the first endoscopic embodiments described above, the combined diagonal dimension and channel diameter will typically be greater than an outer shaft diameter. Other specific aspects of the re-configurable channel described above with respect to the earlier embodiment may also be found in the endoscopes of the second aspect herein.

In the third aspect of the present invention, an endoscope comprises a handle and an elongated shaft. The elongated shaft is mounted to rotate, typically reversibly, at least 180° about a longitudinal axis of the handle. An electronic image sensor is carried near a distal end of the shaft, and electrical leads extend from the image sensor to the handle. The electrical leads are configured to coil and uncoil (spool and unspool) over the shaft as the shaft is rotated in opposite directions about the longitudinal axis. In specific embodiments of this third endoscope structure, the electrical leads may comprise a flex circuit and at least a portion of the flex circuit may have a cross-sectional area that is less than 5% of the cross-sectional area of the shaft assembly.

In a fourth aspect of the present invention, an endoscope comprises a handle in a elongated shaft mounted to rotate by at least 180° about a longitudinal axis of the handle. A flow channel extends though the shaft assembly to a port in a distal end of the shaft. The flow channel has a proximal channel portion fixed in the handle and a distal channel portion that rotates together with the shaft. A fluid-tight housing intermediate the proximal and distal channel portions is configured to provide a fluid-tight path through the channel portions within the full rotational range of the shaft.

In specific aspects of the fourth endoscope of the present invention, the rotating shaft may include an annular flow channel that rotates in the housing. The endoscope may still further include a second flow channel extending through the handle and shaft assembly, where the second flow channel has a proximal channel portion fixed in the handle component and a distal channel portion that rotates in the shaft as the flow channel rotates in the housing.

The illumination source discussed herein can comprise an incandescent light, an LED, an illumination source that radiates non-visible light, as well as any light transmitting material (e.g., a fiber) that transmits light from an illumination source.

The descriptions provided herein are examples of the invention described herein. It is contemplated that combinations of specific embodiments, specific aspects or combinations of the specific embodiments themselves are within the scope of this disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

Additional aspects of the invention will become clear from the following description of illustrative embodiments and from the attached drawings, in which:

FIG. 1 illustrates components of a hysteroscopic treatment system corresponding to the invention, including a perspective view of an endoscopic viewing system and schematic view of a fluid management system.

FIG. 2 is perspective view of the endoscopic viewing system of FIG. 1 showing a single-use disposable endoscope component separated from a reusable handle component.

FIG. 3A is perspective view of single-use endoscope component of FIG. 2 with the handle shell partially removed to show an interior portion of the component.

FIG. 3B is perspective view of endoscope component of FIG. 3A with a flow channel housing removed to show features of a rotating shaft assembly.

FIG. 4 is a perspective view of the endoscopic viewing system of FIG. 1 from a different angle illustrating rotation of the rotating shaft assembly.

FIG. 5 is another perspective and sectional view of endoscope component of FIGS. 3A-3B with a flow channel housing removed to show the central axis of the working channel around which the shaft assembly rotates and the off-center longitudinal axis of the outer sleeve of the endoscope shaft.

FIG. 6 is an enlarged perspective view of the endoscopic viewing system of FIGS. 1 and 2 showing the finger-actuated control panel in the reusable handle component and the sterile and non-sterile fields of the components.

FIG. 7A is an enlarged perspective view of the distal end of the endoscope shaft showing the working channel with a distal channel portion in a reduced cross-sectional configuration for introduction into a patient's body.

FIG. 7B is another view of the distal end of the endoscope shaft of FIG. 7A showing the distal working channel portion in an expanded cross-sectional configuration when a tool is introduced through the working channel.

FIG. 8 is another view of the distal end of the endoscope shaft assembly of FIGS. 7A-7B showing the image sensor housing extending distally from the distal surface of the outer sleeve tip.

FIG. 9 is another view of the endoscope handle assembly which carries at least one accelerometer for image orientation.

FIG. 10 is a de-constructed view of the endoscope working end showing a flex circuit configuration.

FIG. 11 is another view of the endoscope working end of FIG. 10 .

FIG. 12A is another view of the endoscope working end of FIG. 11 in a non-articulated configuration.

FIG. 12B is another view of the endoscope working end of FIG. 112A in an articulated configuration.

FIG. 13 is an exploded view of the components of the endoscope working end of FIGS. 11, 12A and 12B.

FIG. 14 is a perspective view of a housing and lens assembly in the distal end of an endoscope similar to that of FIGS. 10, 11, 12A and 12B showing a single flex circuit with multiple bends or folds therein for coupling electrical leads to the image sensor and to two LEDs.

FIG. 15 is an exploded view showing the insulator layers in conductive layers of the flex circuit in a plane and showing the multiple leads that connect to the image sensor and the LEDs.

FIG. 16 is a perspective view of the proximal portion of the flex circuit FIG. 15 showing the electrical leads that couple to the circuit board in the endoscope handle.

FIG. 17A is a perspective view of the distal portion of the flex circuit FIG. 15 after a first folding step where segments of the flex circuit folded after coupling to the LEDs to orient light emission from the LEDs in a selected direction.

FIG. 17B is a perspective view of the distal portion of the flex circuit FIG. 17A after a second folding step where a portion of the flex circuit is folded orient the image sensor field of view in the distal direction relative to the shaft of the endoscope.

FIG. 18A is a view of an endoscopic video image on a video display.

FIG. 18B is a view of the endoscopic video image on the video display of FIG. 18A showing a warning indicator in the form of a colored annular ring around the image.

FIG. 19A is a view of an endoscopic video image as in FIG. 18A.

FIG. 19B is a view of the endoscopic video image on the video display of FIG. 19A showing an annular warning indicator having a first width.

FIG. 19C is a view of the endoscopic video image and annular warning indicator of FIG. 19B having a second width around the image.

FIG. 20A is a view of an endoscopic video image as in FIG. 18A

FIG. 20B is a view of the endoscopic video image of FIG. 20A showing a warning indicator in the form of a partly annular ring around the image.

FIG. 20C is a view of the endoscopic video image and partly annular ring rotating around the image.

FIG. 21 is a view of the endoscopic video image in the central portion of a video display and a background portion surrounding the image, wherein each of the central and background or peripheral portion have a certain number of pixels associated therewith.

FIG. 22 is a perspective view of a resection probe of the invention.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1 illustrates a hysteroscopic treatment system 50 corresponding to the invention which comprises multiple components including an endoscopic viewing system 100 and a fluid management system 105 housed in a base unit or console 108. The base unit 108 also carries a controller 110A and power source for operating the system 50 and can include an image processor 110B for processing signals from an image sensor carried by the endoscopic viewing system. A display 112 can be coupled to the base unit 108 for viewing images provided by the endoscopic viewing system 100.

More in particular, the endoscopic viewing system 100 of FIGS. 1 and 2 includes a re-usable handle component 120 with a finger-actuated control pad 122 and a disposable single-use endoscope component 125 with an elongated endoscope shaft 126 that carries a distal electronic imaging sensor 128 (see FIGS. 1 and 7A). The fluid management system 105 includes a first peristaltic inflow pump 140A and second peristaltic outflow pump 140B, a fluid source 142 and fluid collection reservoir 144 which can include a fluid deficit measurement subsystem as is known in the art. Each of the systems and subsystems will be described in more detail below.

Referring to FIGS. 1, 2 and 3B, it can be seen that the endoscopic viewing system 100 includes a handle component 120 and a detachable single-use endoscope component 125. In FIG. 2 , the single-use endoscope component 125 can be seen as an assembly of a proximal handle housing 145 which carries a rotating shaft assembly 150 that is configured to rotate the handle housing 145.

Referring to FIGS. 1, 3B and 5 , the rotating shaft assembly 150 includes a proximal cylindrical grip 152 that is coupled to a molded rotating core 155 that in turn is coupled to elongated outer sleeve 160 that extends to the distal working end 162 the endoscope component 125 (FIG. 1 ). The rotating shaft assembly 150 rotates around a rotational axis 165. A working channel 170 extends about axis 165 through the rotating shaft assembly 150 from a proximal port 172 (see FIGS. 2 and 6 ). The working channel sleeve 174 that carries the working channel 170 can be seen in FIGS. 3A, 3B and 5 . Thus, the shaft assembly 150 rotates about the central longitudinal axis 165 of the working channel 170. As can be seen in FIGS. 5 and 7A, the outer sleeve 160 has a central longitudinal axis 175 that is offset from the longitudinal axis 165 around which the shaft assembly 150 rotates. FIG. 4 shows that the grip 152 has a visual marker 178 that is aligned with the offset distal tip section 185 to allow the operator to know the orientation of the image sensor 128 by observation of the grip 152.

In FIGS. 1, 4, 6 and 7A, it can be seen that the endoscope shaft 126 and more particularly the outer sleeve 160 extends in a straight proximal sleeve portion 180 to an offset distal tip section 185 with an axis 182 that is also from 2 to 10 mm offset from the central axis 175 of the outer sleeve 160 (FIG. 7A). The outer sleeve 160 has a transition section 186 that extends at an angle ranging between 10° and 45° over a length of 5 to 20 mm between the straight proximal sleeve section 180 and the offset distal tip section 185. The imaging sensor 128 is disposed at the distal end of the offset tip section 185 (see FIG. 7A). As can be seen in FIGS. 5 and 7B, the endoscope component 125 and more in particular the working channel 170 is adapted to receive an elongate tool 188 that can be introduced through the working channel 170. In one variation, the elongated outer sleeve 160 in each of the straight, transition and distal tip sections (180, 186 and 185, respectively) has a diameter ranging between 4 mm and 10 mm with an overall length configured for use in hysteroscopy. More commonly, the diameter of endoscope shaft 126 is from 5 mm to 6 mm in diameter. It has been found that the endoscope shaft 126 with the angled transition section 186 and offset distal tip section 185 can be introduced through a patient's cervical canal without dilation beyond the dilation necessary for the profile or diameter SD of the straight proximal sleeve section 180. In other words, the tissue around the patient's cervical canal conforms to the angles in the endoscope shaft 126 as the shaft is being advanced through the cervical canal.

In one variation, the handle housing 145 of endoscope component 125 is adapted for sliding, detachable engagement with the handle component 120 as can be best seen in FIGS. 2 and 4 . As can be easily understood, when assembled, the operator can grip the pistol grip handle component 120 with one hand and rotate the cylindrical rotating grip 152 with the fingers of the other hand to rotate the endoscope shaft and image sensor 128 to orient the viewing angle of the image sensor 128 and a tool 188 to any desired rotational angle. As will be described below, the rotating shaft assembly 150 can be rotated at least 180° and more often at least 270° (FIGS. 3B and 5 ). In one variation, the shaft assembly 150 can be rotated 360° so as to orient the image sensor 128 in any superior, lateral or downward direction relative to the handle housing 145.

As can be seen in FIG. 2 , the handle housing 145 carries a projecting electrical connector 190A that is adapted to couple to a mating electrical connector 190B in the handle component 120. While FIG. 2 illustrates that the endoscope component 125 is configured for axial sliding engagement with the handle component 120, it should be appreciated that the angled pistol grip portion 192 of the handle component 120 could plug into the endoscope component 125 in a different arrangement, such as a male-female plug connector or a threaded connector aligned with the axis 194 of the angled grip portion 192. As will be described below, the endoscope component 125 comprises a sterile device for use in the sterile field, while the handle component 120 may not be sterilized and is typically adapted for use in a non-sterile field. A cable 195 extends from the handle component 120 to the base unit 108, imaging processor 110B and controller 110A which includes a power source (see FIG. 1 ).

As can be seen in FIGS. 1 and 2 , the endoscope component 125 includes fluid inflow tubing 200A and fluid outflow tubing 200B that communicate with the fluid management system 105 which is shown schematically in FIG. 1 . As can be understood from FIGS. 2, 3A and 3B, the endoscope handle housing 145 can consist of two injection molded plastic shell elements, 204 a and 204 b (see FIG. 4 ), and FIG. 3A shows one shell element 204 a removed to show the interior of the handle housing 145. It can be seen that both the inflow tubing 200A and outflow tubing 200B are coupled to an injection molded flow channel housing 205 with an interior bore 208 that is configured to receive a rotating core 155 of the rotating shaft assembly 150.

FIG. 3B is another view similar to that of FIG. 3A with the second shell element 204 b removed and the flow channel housing 205 also removed (phantom view) to illustrate how the stationary inflow and outflow tubing, 200A and 200B, communicate with the inflow and outflow pathways in the rotating shaft assembly 150 which rotates at least 180°.

Referring to FIGS. 3A and 3B, it can be seen that the rotating core 155 is centrally aligned with the axis 165 of working channel 170 and is further coupled to the off-center elongated outer sleeve 160 of the endoscope shaft 126. The proximal end 212 of the rotating core 155 is fixed to the grip 152 for rotating the rotating core 155 in the flow channel housing 205.

The rotating core 155 includes first, second and third flanges 218 a, 218 b and 218 c which define annular flow channels 220 and 222 therebetween. It can be seen that annular channel 220 is disposed between the first and second flanges 218 a and 218 b. Annular channel 222 is disposed between the second and third flanges 218 b and 218 c. Each of the first, second and third flanges 218 a, 218 b and 218 c carry an outer O-ring 224 a, 224 b and 224 c. From the views of FIGS. 3A and 3B, it can be understood how the rotating flanges 218 a-218 c rotate in the bore 208 of the flow channel housing 205 and the O-rings 224 a-224 c maintain a fluid tight seal between the annular flow channels 220 and 222.

Again referring FIGS. 3A and 3B, it can be seen that the distal end 230 a of inflow tubing 200A is fixed in the flow channel housing 205 to communicate with annular flow channel 222. Similarly, the distal end 230 b of outflow tubing 200B is fixed in the flow channel housing 205 to communicate with annular flow channel 220. Thus, each of the annular flow channels 222 and 220 can rotate up to 360° and communicate with the stationary distal ends of the inflow tubing 200A and outflow tubing 200B.

FIG. 3B further shows how the annular flow channels 222 in 220 communicate with separate flow pathways that extend through the interior of the elongated sleeve 160 to the working end 162 of the endoscope shaft 126. The fluid inflow pathway can be seen in FIG. 3B which extends through annular gaps AG around the exterior of inner sleeve portion 235 of the rotating core 155 within the second annular channel 222. Such annular gaps AG extend distally to communicate with the interior bore 242 of the outer sleeve 160. In one variation, the pathway within said interior bore 242 transitions to the inflow sleeve 244 with distal outlet 245 as shown in FIGS. 7A-7B.

The fluid outflow pathway also can be seen in FIG. 3B wherein an opening 250 is provided in the inner surface of annular space 220 of the rotating core 155 which communicates with the interior working channel 170. Thus, the outflow pathway from a working space in one variation comprises the working channel 170 which is fully open for fluid outflows when there is no tool 188 in the working channel. In FIG. 5 , it can be seen that a tool seal 252 is shown in the proximal region of the working channel 170 that seals the channel 170 and also permits the tool 188 to be introduced therethrough. Many types of seals are known such in the art as silicone sleeve seals, flap seals and the like. Typically, when a tool is introduced through the working channel 170, the tool itself will provide an outflow channel. Thus, the use of the working channel 170 as outflow passageway is adapted for diagnostic procedures when using the endoscope without a tool in the working channel.

In a method of use, the endoscope shaft 126 can be navigated through a patient's end cervical canal with the inflow and outflow pumps 140A and 140B (see FIG. 1 ) operating to provide continuous irrigation through the distal tip section 185 of the endoscope component 125 together with endoscopic viewing by means of image sensor 128. Such a variation will thus allow fluid inflows through annular channel 222 and fluid outflows through the working channel 170 and annular channel 220.

Now turning to FIGS. 7A-7B, the endoscope shaft 126 has a small insertion profile or configuration that consists of the outer diameter of the elongated outer sleeve 160 which includes the proximal straight section 180, the angled transition section 186 and the distal tip section 185 (FIG. 7A). It can be seen in FIG. 7A that the distal tip section 185 carries an image sensor 128 and two LEDs 260 which require an electrical connection to base unit 108, the controller 110A and imaging processor 110B. In order to provide the large number of electrical leads required for the image sensor 128, it was found that conventional multi-wire electrical cables were too large to be accommodated by the small diameter outer sleeve 160 which also accommodates working channel 170, an inflow channel 244 and potentially other fluid flow channels. For this reason, it was found that a printed flex circuit in the form of a flat ribbon 265 (FIG. 5 ) could provide from 10 to 40 electrical leads and occupy only a thin planar space within the endoscope shaft 126. FIG. 7A shows the flex circuit ribbon 265 extending from the image sensor 128 proximally within outer sleeve 160. In one variation shown in FIGS. 3A, 3B, 5 and 7A, a second flex circuit ribbon 270 is provided to power the LEDs 260. In another variation, the first flex circuit ribbon 265 could potentially carry electrical leads to the image sensor 128 and to the two LEDs 260.

Now turning to FIGS. 3A, 3B and 5 , mechanisms are illustrated that provide for needed slack in the electrical circuitry or flex circuit ribbons 265 and 270 for accommodating rotation of the rotating shaft assembly 150 relative to the handle housing 145 (FIG. 3A). As can best be seen in FIGS. 3B and 5 , the rotating shaft assembly 150 includes a first or distal spool 280 around which the flex circuit ribbon 265 can be coiled or spooled. The distal spool 280 is formed as a part of the rotating core 155 of the rotating shaft assembly 150. Any suitable length of the flex circuit ribbon 265 can be provided as needed to allow for at least 180° rotation, or more often, 360° of rotation of the rotating shaft assembly 150 relative to the handle housing 145. In the variation shown in FIGS. 3B and 5 , it can be seen that a second or proximal spool 285 comprises a portion of the rotating core 155 and is adapted for receiving a slack length of the second flex circuit ribbon 270 that extends to the two LEDs 260. In FIGS. 3B and 5 , it can be seen that the proximal ends 265′, 270′ of the flex circuit ribbons 265, 270 are coupled to electrical connector 190A by plug connector 288 a and 288 b. While the variation of FIGS. 3A-3B shows the endoscope handle accommodating the flex circuit ribbon 265 in a spool 280, it should be appreciated that the slack portion of the flex circuit ribbon can be configured with at least one of a coiled form, spiral form or folded form without a spool.

In one aspect of the invention, referring to FIG. 7A, an endoscope shaft 126 is provided that carries a distal image sensor 128 wherein the diameter of a working channel 170 in the shaft 126 is greater than 50% of the outer diameter of the shaft 126 and the electrical leads to the image sensor 128 comprise the flex circuit 265. In such a variation, the flex circuit ribbon has a thickness of less than 0.4 mm and a width of less than 5.0 mm. More often, the flex circuit ribbon has a thickness of less than 0.3 mm and a width of less than 4.0 mm. Further, in this variation, the flex circuit ribbon carries at least 10 electrical leads of often more than 15 electrical leads. In another aspect, electrical leads extending to the image sensor 128 are in a cable or ribbon that has a cross-section that is less than 5% or the cross-section of the endoscope shaft 126. In another aspect of the invention, the endoscope comprises a shaft carrying a distal image sensor, a working channel extending through the shaft wherein the working channel in a distal shaft portion is re-configurable between a constricted shape and a non-constricted shape to accommodate a tool introduced therethrough, wherein the combined diagonal dimension DD of the sensor and the diameter WCD of the working channel 170 is greater than the shaft diameter SD in its insertion configuration or profile (see FIGS. 4, 6 and 7A).

In a specific example, the image sensor 128 is available from OmniVision, 4275 Burton Drive, Santa Clara, Calif. 95054 with the part name/number: High Definition Sensor OV9734 with a 1280×720 pixel count. The sensor 128 has package dimensions of 2532 μm×1722 μm, with a diagonal DD of 3062 μm or 3 mm. Further, the proximal shaft (outer) diameter SD is 5 mm with the working channel diameter WCD being 3 mm. Thus, the combined sensor diagonal DD (3 mm) and the working channel diameter WCD (3 mm) equals 6 mm which is greater than the outer shaft diameter of 5 mm. In this example, the flex circuit ribbon is 3.4 mm in width and 0.2 mm thickness with a cross-sectional area of 0.68 mm² which is 3.52% of the 5 mm diameter shaft having a cross-sectional area of 19.63 mm². In this specific variation, the flex circuit ribbon 265 carries 19 electrical leads.

Referring again to FIGS. 7A-7B, the distal portion of the endoscope shaft 126 includes a distal working channel portion 170′ that is re-configurable between a first smaller cross-section as shown in FIG. 7A for accommodating fluid outflows and a second larger cross-section as shown in FIG. 7B for accommodating a tool 188 introduced through the working channel 170 and its distal portion 170′.

In one variation as shown in FIGS. 3A-3B, 5, 6, and 7A, it can be seen that the working channel sleeve 174 that defines working channel 170 extends in a straight configuration through the endoscope component 125 from its proximal opening port 172 to its open distal termination 290. As can be seen in FIGS. 7A and 7B, the distal end 292 of sleeve 174 has a superior surface 294 that is straight and rigid. The working channel sleeve 174 has an inferior or lower sleeve portion 296 that is flexible and in one variation has a living hinge portion 298 below sidewall cut-outs 302 a and 302 b in the sleeve 174. Further, the distal end of the endoscope shaft 126 includes an elastomeric sleeve 310 that surrounds the angled transition sleeve section 186, the distal tip section 185 as well as a distal portion 312 of the proximal straight sleeve section 180 (FIG. 7B). Thus, as can be seen in FIG. 7A, the elastomeric sleeve 310 has sufficient elastic strength to collapse or constrict the working channel portion 170′ to the smaller cross-section as seen in FIG. 7A.

As can be seen in FIG. 7A, the lower sleeve portion 296 includes a sleeve wall 315 with sufficient curvature to maintain an open pathway through the distal working channel portion 170′ when the elastomeric sleeve 310 constricts the distal channel portion 170′ which thereby always provides an open fluid outflow pathway. For example, the sleeve wall 315 can have a curvature representing the same diameter as a proximal portion of sleeve 174 and extend over a radial angle ranging from 30° to 90°. While the lower sleeve portion 296 shown in FIG. 7A comprises a portion of the wall of metal sleeve 174, in another variation, the flexible lower sleeve portion 296 may be any bendable plastic material or a combination of plastic and metal.

FIG. 7B next shows the distal working channel portion 170′ in its second expanded configuration as when a physician inserts an elongated tool 188 (phantom view) through the working channel 170. Such a tool 188 will initially slide along the hinge portion 298 of the lower sleeve portion 296 and then stretch the elastomeric sleeve 310 to open distal working channel portion 170′ to allow the tool 188 to extend through the working channel. In other words, the elastomeric sleeve 310 will be stretched or deformed to a tensioned position as shown in FIG. 7B as a tool is inserted through the distal working channel portion 170′. When the tool 188 is withdrawn from the working channel portion 170′, the elastomeric sleeve 310 will return from the tensioned position of FIG. 7B to the repose or non-tensioned position of FIG. 7A to return the working channel portion 170′ to the constricted configuration FIG. 7A.

In general, the endoscope component 125 corresponding to the invention allows for the use of an image sensor 128 having a large diagonal dimension relative to the insertion profile or diameter of the endoscope shaft 126 while at the same time providing a working channel 170 that has a large working channel diameter WCD relative to the insertion profile or diameter of the endoscope shaft assembly 126. More in particular, the endoscope component 125 comprises endoscope shaft 126 having a shaft diameter SD extending to a distal sleeve section 185, an image sensor 128 with a diagonal dimension DD carried by the distal sleeve section 185 and a working channel 170 having a diameter WCD extending through the elongated shaft 126, wherein the working channel portion 170′ in the distal end of the shaft 126 is adjustable in shape to accommodate a tool 188 introduced therethrough and wherein the combination or the sensor's diagonal dimension DD and the working channel diameter WCD is greater than the shaft diameter SD (see FIG. 7A).

In a variation, the sensor diagonal dimension DD is greater than 50% of the shaft diameter SD or greater than 60% of the shaft diameter. In a variation, the working channel diameter WCD is greater than 30% of the shaft diameter, greater than 40% of the shaft diameter or greater than 50% of the shaft diameter. In other words, the working channel portion 170′ in the distal end is adjustable between a first cross-sectional dimension and a second cross-section dimension. In the variation of FIGS. 7A-7B, the working channel portion 170′ in the distal region of the endoscope shaft 126 is adjustable between a partially constricted shape and a non-constricted shape.

In one variation, referring to FIG. 7A, the distal tip section 185 of the endoscope shaft 126 has an axial dimension D1 ranging from 5 mm to 20 mm. Also referring to FIG. 7A, the angled transition sleeve section 186 extends over a similar axial dimension D2 ranging from 5 mm to 20 mm. Still referring to FIG. 7A, the central axis 182 of distal tip section 185 can be parallel to and offset from the longitudinal axis 175 of the straight shaft section 180 by a distance ranging from 1 mm to 10 mm.

Now turning to FIG. 8 , the image sensor 128 is carried in a sensor housing 340 that also carries a lens assembly 345 as is known in the art. In one variation, the housing 340 also carries one or more light emitters, in the variation shown in FIGS. 7A and 7B, two LEDs indicated at 260 are shown carried in opposing sides of the sensor housing 340. Of particular interest, the distalmost surface 350 of the lens assembly 345 and the LEDs 260 are disposed distally outward from the distal surface 352 of distal tip section 185 as shown in FIG. 8 . It has been found that providing such a distalmost surface 350 of the lens assembly and the LEDs outwardly from the distal surface 352 of distal tip section 185 improves lighting from the LEDs 260 as well as improving the field of view of the image sensor 128. The distance indicated at D3 in FIG. 7 can range from 0.2 mm to 2.0 mm.

Now referring to FIG. 7A, another aspect of the invention comprises an optionally dedicated fluid pressure sensing channel 360 that extends through a thin wall sleeve (not shown) in the endoscope shaft 126. As can be seen in FIGS. 7A, the distal end of the pressure sensing channel 360 is open in the distal surface 352 of the endoscope shaft 126. The pressure sensing channel 360 can extend to disposable pressure sensor in the handle housing 145 (not shown). Such a disposable pressure sensor then can have electrical leads coupled through the electrical connector 190A in the handle housing 145 thereby send electrical signals indicating pressure to the controller 110A (FIG. 1 ). Thus, in one aspect, the disposable endoscope component 125 carries a single-use pressure sensor coupled by a detachable connector to a remote controller 110A.

In one variation of a pressure sensing mechanism, referring to FIG. 7A, the wall of the pressure sensing channel 360 consists of a hydrophobic material, which can be any suitable polymer such as PFTE, having an interior diameter ranging from 0.25 mm to 2.5 mm. Often, the diameter of channel 360 is between 0.5 mm and 1.5 mm. It has been found that a hydrophobic surface in a pressure sensing channel 360 will prevent the migration of fluid into the channel and thereby trap an air column in the channel communicating with the pressure sensor. The compressibility of the air column in the pressure sensing channel 360 does not significantly affect the sensed pressure since the channel diameter is very small. In another variation, a metal sleeve can be coated with a hydrophobic surface or an ultrahydrophobic surface.

Now referring to FIGS. 1, 2 and 4 , it can be seen that the handle component 120 has an angled pistol grip portion 192 with an axis 194 that is angled from 10° to 90° away from the axis 175 of the endoscope shaft 126. The grip portion 192 includes a finger or thumb-actuated control pad 122 that carries actuator buttons for operating all the functions of the treatment system, for example, including (i) operating the fluid management system 105, (ii) capturing images or videos from sensor 128, (iii) adjusting light intensity from the LEDs 260, etc. As described above, the control unit 108 typically carries the image processor 110B. However, the interior of the handle component 120 also could carry the image processor 110B or a processing component thereof.

FIG. 4 illustrated the handle component 120 and endoscope component 125 from a different angle where it can be seen that the grip portion 192 has a recessed channel 385 therein that is adapted to receive and lock in place the inflow and outflow tubing, 200A and 200B, so as to integrate the tubing set with the pistol grip 192 during use. This feature is important so that the inflow and outflow tubing will not interfere with operation of the endoscope component 125 or a tool introduced through the working channel 170. The pistol grip 192 can have a single recessed channel 385 to receive both the inflow and outflow tubing or two recessed channels for separately receiving the inflow tubing and the outflow tubing.

Now turning to FIG. 6 , the enlarged view of the assembled handle component 120 and endoscope component 125 shows the control pad 122 with four actuator buttons or switches which are adapted to operate the system. In one variation, actuator 402 is adapted for turning on and off irrigation, or in other words actuating the fluid management system 105 to provide fluid inflow and fluid outflows. Actuator 404 is adapted for image or video capture. In a variation, momentary pressing the actuator 404 will capture a single image and longer pressure on the actuator will operate a video recording.

The actuator or scrolling button 406 has a scrolling function, wherein pressing the scrolling button 406 will cycle through various subsystems, wherein each subsystem then can be further adjusted by the central button or up/down actuator 410, which is adapted for increasing, decreasing or otherwise changing an operating parameter of any selected subsystem. In one example, the scrolling button 406 can be actuated to cycle through the following subsystems and features: (i) fluid inflow/outflow rate from the fluid management system 105; (ii) the set pressure which is to be maintained by fluid management system 105; (iii) fluid deficit alarm which is calculated by the fluid management system 105; (iv) optional selection of still image capture or video capture, and (v) LED light intensity. Then, after scrolling to select a subsystem, the physician can actuate the central up/down actuator 410 to adjust an operating parameter of the selected subsystem. As will be described further below, the selection of subsystems as well as the real-time operating parameters of each subsystem will be displayed on a video monitor or display 112 as shown in FIG. 1 . Thus, it can be understood that the physician may operate the scrolling button 406 to scroll through and select any subsystem or feature while observing such as selection on the display 112, and then actuate the up/down actuator 410 to adjust an operating parameter which also can be observed on the display 112.

In another aspect of the invention, the controller 110A includes a control algorithm for operating the control pad 122 which provides a jump back to a default condition after the scroll button or actuator 406 has been used by the physician. For example, the default condition will be a selected default subsystem which is actuatable by the central up/down actuator 410. In one variation, the default subsystem is the fluid inflow/outflow rate, which may be the subsystem most commonly actuated by the physician to control fluid flow into and out of a working space. As described above, the physician may use the scrolling button 406 to select any subsystem for adjustment of an operating parameter. If, however, the physician does not continue to scroll between the various subsystems or change a parameter within a predetermined time interval, then the control algorithm will jump back to the default subsystem, which may be the fluid inflow/outflow rate. The predetermined time interval, or timeout, for the control algorithm to jump back to the default condition may be anywhere from 1 second to 10 seconds, more often between 2 seconds and 5 seconds.

Still referring to FIG. 6 , the assembly of the handle component 120 with endoscope component 125 is shown with a plane P to illustrate the sterile field 415 and the non-sterile field 420 relative to the endoscope assembly. As can be understood, the disposable endoscope component 125 is sterilized and the physician or nurse would remove the component 125 from sterile packaging which would then define a sterile field 415. The endoscope component 125 then would be mated with the handle component 120 which defines the non-sterile field 420. In other variations (not shown), a plastic film or other plastic housing could cover the handle portion 120.

A method of the invention can also be understood from FIG. 6 . It can be understood that the physician must insert the tool 188 into the working channel 170 in a manner that would ensure the sterility of the tool. As can be seen in FIG. 6 , the grip 152 which is sterile has a large diameter recess R therein which tapers into the proximal port 172 of the working channel 170. In one variation, the diameter of the recess R is at least 15 mm and often greater than 20 mm. The depth of the recess can range from 5 mm to 20 mm or more. Thus, it can be understood that the physician can easily insert the distal end 425 of a tool 188 into the mouth of the large diameter recess R without any risk of contacting the non-sterile handle portion 120. Thereafter, the physician can move the tool distal end 425 distally over the surface 428 of the recess R and into and through the port 172 of the working channel 170. By using this method, the physician can be assured that the tool 188 will not contact the non-sterile field 420.

Now turning to FIG. 9 , another aspect of the invention is shown which relates to electronic mechanisms carried by the endoscope 500 for re-orienting the image on the display in response to rotation of the endoscope shaft 510 to ultimately provide an image-upright configuration on the display. In one variation, an accelerometer 515 (which can comprise an accelerometer gyroscope combination) is provided which can send signals to a controller and image processor related to rotation of the endoscope shaft 510. For example, an STmicro IIS2DH 3-axis accelerometer can be used or a 6-axis IMU (Inertial Motion Unit) with 3-accelerometer and 3-gyroscope axis such as an STmicro ISM330DLC can be used.

The image processor in the controller then can use the accelerometer signals to calculate a necessary amount of rotational correction for the image re-orientation. The calculation includes the degree of rotation of the shaft 510 relative to the longitudinal axis 518 of the shaft 510. The image is then electronically rotated to display on any video display or monitor can be carried by the handle of the device or most often is a remote display. Thus, the video image on the display can at all times be in an image-upright configuration for viewing by the physician.

As can be seen in FIG. 9 , the accelerometer 515 is carried on the proximal spool 285 which is rotatable within the handle assembly 520. Thus, any rotation of the rotating component 522 independent of the handle 524 or rotation of the handle 524 relative to the longitudinal axis 518 of the shaft will be sensed by the accelerometer 515 to thus allow reorientation of the image on the display. In the variation of FIG. 9 , a second accelerometer 540 is carried on the circuit board 545 which is fixed in the non-rotating handle 524. Thus, signals from this accelerometer 540 provide signals of rotation of the handle only. In one variation, signals from both accelerometers 515, 540 can be compared to determine rotation of the rotating component relative to the handle 524. In one aspect, signals from the second accelerometer 540 can be used if signals from the first accelerometer 515 fail for any reason. An alert on the display can indicate to the user if either the first or second accelerometer has failed to perform properly.

FIGS. 10 and 11 illustrate another variation of an endoscope working end 550 which is similar to the previous embodiment. The thin-wall outer sleeve 552 is in phantom view in FIG. 10 and the thin-wall working channel sleeve 554 is shown. As described previously, electronic signals from the image sensor 555 (FIG. 11 ) as well as power for the image sensor and LEDs 558A and 558B are carried in a flex circuit 560 extending through the shaft 510 of the endoscope. Since the endoscope shaft 510 will be operating in a fluid environment, it has been found that significant RF shielding is needed around the signal-carrying electrical conductors in the flex circuit 560 to ensure that potential electrical devices introduced through the working channel 564 will not generate electrical fields that may interfere with signals carried in the flex circuit 560.

Thus, in one variation shown in FIG. 10 , the flex circuit may be an edge-coupled stripline design where two outer dielectric layers 562 a and 562 b carry electrical conductors 565 (including ground planes) and are configured to function as a shield relative to the electric conductors 570 disposed in a middle layer 572 between the two outer layers 562 a and 562 b. In this variation, the plurality of electric conductors 570 disposed in the middle layer 572 are adapted to carry all the signals from the image sensor 555. Thus, the two outer layers 562 a and 562 b function as a shield to prevent any potential interference from electrical tools that might interfere with the signals carried by the interior conductors 570 in the middle layer 572.

In one variation, the signal carrying conductors 570 in the middle layer 572 are provided with a dielectric insulator layer on both sides that has a thickness of at least 0.0005″, at least 0.001″ or at least 0.002″. The insulator layers can be any suitable power material such Kapton.

In some variations, the number of electrical conductors 570 that carry image signals in the middle layer 772 can vary from 4 to 24 or more and typically range from 12 to 20 conductors. In this variation, the electrical leads to the LEDs 558A and 558B are also carried in the middle layer 572 which could be subject to interference from electrical tool. Thus, providing the electrical leads and signal conductors in the middle layer 572 in the stripline design allows for an overall flex circuit 560 that is thinner and more flexible than other configurations that provide adequate RF shielding.

Now turning to FIGS. 11-13 , the endoscope shaft working end 550 is similar to that of FIGS. 7A and 7B. In the variation of FIG. 11 , the shaft working 550 end has a secondary flexible hinge portion 580 which allows for changing the angle of the field of view FOV of the image sensor 555 about its axis 572. For introduction into a working site in the patient's body, the working end 550 of the shaft 510 has a distal segment 585 that has an axis 588 that is angled relative to the longitudinal axis 590 of the shaft 510 at a selected angle which can be from 5° to 30°. It can be seen in FIG. 11 that a second or intermediate segment 595 of the working end 550 includes a living hinge portion 580 which allows it to flex relative to the proximal shaft segment 600. The intermediate segment 595 and distal segment 585 are fixed together at an angle which can be seen in FIGS. 11 and 12A. The mechanism for actuating the distal segment 585 and intermediate segment 595 to a flexed position (see FIG. 12B) consists of inserting an elongated tool body or shaft 604 through the working channel 564 as described previously.

FIGS. 12A and 12B are schematic transparent views of the working end 550 of FIG. 11 showing the interior working channel 564 and the proximal shaft segment 600, the intermediate shaft segment 595 and the distal shaft segment 585. In FIG. 12 B, it can be seen that the elongated tool body 604 (phantom view) has been inserted through the working channel 564 which causes multiple effects. First, as described previously, the elongated tool shaft 604 stretches the resilient silicone sleeve 610 around the working end 550 (FIG. 11 ) to expand the working channel 564 from a collapsed condition to an expanded condition. At the same time, the introduction of the tool shaft 604 through the working channel 564 flexes the proximal hinge 580 at the proximal end of the intermediate segment 595 to cause the intermediate and distal segments 595 and 585 to flex away from the repose position (FIG. 12A) to a tensioned position (FIG. 12B) wherein the axis 588 of the image sensor 555 is parallel to the longitudinal axis 518 of the proximal shaft portion 600. In this flexed position of FIG. 12B, the image sensor 555 then is aligned with the longitudinal axis 518 of the shaft and the sensor axis 572 and the angle of the field of view FOV then can be 0° relative to the longitudinal axis 518 of the shaft.

In this variation shown in FIG. 11 , it can be seen that the tensioning support sleeve 625 is shown which partially surrounds the proximal endoscope shaft portion 600 and sleeve segment 595. More in particular, the support sleeve 625 has an upper surface 628 that is fixed to the adjacent upper surface 630 of the proximal shaft portion 600. The support sleeve 625 has a longitudinal discontinuity 626 therein and the sleeve extends around the shaft from about 200° to 360°. It can further be seen in FIG. 11 that the support sleeve with a length LL which extends over a portion of the proximal shaft 600 and over a portion of the intermediate sleeve 595. As can be seen in FIGS. 11 and 13 , the interior portion of the support sleeve 625 has the longitudinal gap or discontinuity 626 which allows the side portions 640 a and 640 b to be flexed outwardly when an elongated tool shaft 604 is introduced through the working channel 564. In this aspect, the support sleeve 625 functions as a spring which urges the support sleeve 625 radially inwardly to return the endoscope shaft 510 to a straight configuration when the tool shaft 604 is removed from the working channel 564.

In another aspect of the invention referring to the exploded view of FIG. 13 , it can be seen that the distal end of the distal shaft segment 595 includes a housing 650 that carries both the image sensor 555 and first and second LEDs 558A and 558B. The housing 650 can be molded out of any suitable polymer and includes means for providing flex circuit connections to both the image sensor 555 and the LEDs. An upper guide surface 655 is coupled to the sensor housing 650 to provide a sliding interface against which the tool shaft 604 can push and deflect the distal segment 585 and sensor housing 650. A lower guide surface 660 is coupled by a flexible element 664 to the working channel sleeve 554 to provide a sliding interface against which the tool shaft 604 can open the working channel 564 without contacting the silicone sleeve 610 (see FIG. 11 ).

Now turning to FIGS. 14 through 17B, another variation of components of an endoscope working end 700 is shown which includes a distal housing 704 that carries an image sensor 705 (FIG. 17B) and lens stack 708 together with a flex circuit 710 that is configured for coupling to the image sensor as well as two LEDs 715A and 715B. In one aspect of the invention, the elongated flex circuit 710 is adapted to be carried in the interior of the endoscope shaft or sleeve 720 in a channel that can be used for fluid inflows and fluid outflows. Thus, the flex circuit 710 and its connections to the image sensor and LEDs are entirely insulated to allow for its use when submerged in such fluid flows.

As can be understood with reference to FIGS. 3A-3B, 5, 10, 12A-12B and 13 , previous variations of the endoscope of the invention are shown with a flat flex circuit extending through a fluid flow channel in the elongated shaft of the endoscope. It has been found that typical insulator layers on flex circuits are suited for operating in an air environment where electrical coupling through the surface insulator is not problematic. However, it has been found to be challenging when such a flex circuit carries sensitive conductors from an image sensor and when the flex circuit is submerged in a fluid environment and in particular in a conductive saline fluid inflow or outflow. The endoscope of the present invention includes an integrated fluid management system and therefore the flex circuit has to be effectively insulated to prevent noise in the image sensor conductors.

Referring to FIG. 15 , the first or superior insulator layer 725A and the last or inferior insulator layer 725E of the flex circuit 710 comprise dielectric layers that are thick enough to prevent capacitive coupling therethrough to the image sensor conductors indicated at 742 in FIG. 15 . In one variation, the superior and inferior dielectric layers 725A and 275E each comprise a polymeric layer having a thickness of at least 0.002″. In other variations, the dielectric layers each are at least 0.003″ or at least 0.004″. In one variation, the dielectric layer can be a polyamide such as Kapton®. In general, a flexible circuit for an endoscope used in a fluid environment corresponding to the invention comprises an elongate flexible circuit extending in a planar shape to a distal end, an image sensor operatively coupled to a surface of the flex circuit with a first arrangement of electrical conductors therein, an illumination source operatively coupled to a surface of the flex circuit with second arrangement of electrical conductors therein, where said first arrangement of electrical conductors is disposed in an interior of the flex circuit with superior and inferior dielectric layers sufficient to prevent electrical coupling through said dielectric layers to thereby prevent interference with image sensor signals carried by said first arrangement of electrical conductors. FIG. 14 is a perspective view of the housing 704 and lens assembly or stack 708 in the distal working end 700 of an endoscope similar to that of FIGS. 10, 11, 12A and 12B. It can be seen that a single flex circuit 710 is shaped for folding to allow the image sensor 705 and the LEDs 715A, 715B to be oriented distally or aligned with the longitudinal axis 722 of the endoscope shaft. Thus, the multiple electrical leads to the image sensor 705 and to two LEDs can be provided in a single flex circuit which conserves space in the endoscope shaft which is critically important.

FIG. 15 is a perspective view of the distal portion of the flex circuit 710 of FIG. 14 in an exploded view showing the five thin film layers that comprise the flex circuit 710 in a planar form before bonding into the single component. The first layer 725A or layer 1 comprises a thin-film insulator layer which covers the electrical leads in the second layer 725B or layer 2. A central portion of the distal end of the layer 1 indicted at 725A includes an open port 728 that exposes the electrical leads in layer 2 (725B) for coupling to the image sensor 705 as shown in FIG. 17A. It can be seen in FIG. 15 that layers 1 through 4 of the flex circuit 710 are configured with first and second legs 730A and 730B that extend laterally or perpendicular to the axis 732 of the flex circuit which are adapted to couple to the LEDs as will be described below.

The second layer 725B or layer 2 of the flex circuit carries a plurality of electrical leads 735 that extend to the image sensor 705. Layer 3 indicated at 725C of the flex circuit carries a planar ground element 740. Layer 4 indicated at 725D of the flex circuit carries additional electrical leads 742 coupled to the image sensor 705 as well as leads that couple the two LEDs in a series connection. Layer 5 indicated at 725E of the flex circuit 710 does not have a shape with laterally-extending legs 730A and 730B corresponding to the shape of the layers 1 through 4. Layer 5 is configured as a stiffener layer with a distal end 748 that defines a bending region 750 extending transversely across the flex circuit 710 to provide a bending line for layers 1 through 4 when bonded together (FIGS. 17A-17B).

In FIG. 15 , it can be seen that layers 1 through 4 (725A-725D) include notch features for inducing bending of the flex circuit at selected locations. More in particular, notch features 755 provided on either side of the flex circuit 710 define a transverse line to induce bending of the flex circuit perpendicular to the longitudinal axis 732 as can be seen in FIGS. 17A and 17B. The laterally-extending legs or segments 730A and 730B also include notches 758 which are adapted to induce bending of such laterally-extending segments as also can be seen in FIGS. 17A and 17B.

FIG. 16 shows the proximal ends of layers 1 through 4 (725A′-725D′) of the flex circuit 710 in an exploded view with layer 1 (725A′) having an open port 760 to expose the electrical connection points 762 in layer 2 (725B′) which are adapted for coupling to a circuit board in the endoscope handle (not shown).

FIG. 17A is a perspective view of the distal portion of the flex circuit 710 of FIG. 15 showing the image sensor 705 and the LEDs 715A, 715B coupled to the flex circuit. In addition, it can be seen that the laterally-extending segments 730A and 730B are folded 90° away from the planar shape of the flex circuit as in its manufactured form shown in FIG. 15 . The axis 765 of the field of view (FOV) of the image sensor is also shown. FIG. 17B then shows the transverse bending of the flex circuit 710 which then orients the axis 765 of the image sensor's field of view and the light transmission axes 770 of the LEDs in the distal direction. Thus, FIG. 17B is a schematic view of the components in the working end 700 of FIG. 14 where FIG. 17B does not show the lens housing 704 or the lens stack 708 with the outer sleeve 720 in phantom view. Referring to FIG. 14 , it should be appreciated that the outer or distal tips 780 of the laterally extending segments 730A and 730B can be folded inwardly at point 782 (FIGS. 14 and 15 ) to attach to the proximal surface of the LEDs 715A, 715B or can be adapted to couple to the side of the LEDs or a circuit component attached to the LEDS as in FIGS. 17A and 17B.

In general, a flex circuit for an endoscope corresponding to the invention comprises an elongated flexible circuit manufactured to extend in a planar shape to a distal end having first and second flex elements adapted to bend away from the planar shape, an image sensor having a field of view (FOV) axis operatively coupled to a surface of the first flex element, and an LED with a light axis operatively coupled to a surface of the second flex element, wherein the first and second flex elements are capable of bending away from the planar shape to a non-planar shape for coupling to an endoscope shaft or housing where the FOV axis and light axis are in a distal-facing orientation after bending. It is understood that variations can employ any illumination source in addition to, replacing, the LED.

In another aspect, a flexible circuit assembly of the invention comprises an elongated flexible circuit member, an image sensor and at least one LED coupled to a distal portion of the flexible circuit member in a first spaced apart configuration, wherein said distal portion is configured for deformation or folding to dispose the image sensor and the at least one LED in a second spaced apart configuration for coupling to a distal housing of an elongated endoscope shaft that carries a lens or lens stack for the image sensor.

In another aspect a flexible circuit of the invention comprises an elongated flat flexible circuit member extending in a plane from a proximal end to a distal end and an image sensor operatively coupled to a first surface of the flexible circuit member where the sensor field of view is orthogonal to said first surface wherein a distal portion of the flexible circuit member carrying the image sensor is configured for flexing away from said plane for coupling to a distal portion of an elongated endoscope shaft to thereby re-orient the sensor field of view at an angle relative to the plane of the flex circuit member.

FIGS. 18A-18B illustrate another aspect of the invention which comprises a view of an endoscope video image 800 on a video display or screen 805 and a warning indicator or visual alert mechanism. As can be seen in FIG. 18A, a working space 806 with a body lumen 807 and a grasper 808 are within the field of view of the endoscope. Typically, the video image 800 is shown on a rectangular display or screen 805 where the actual image of the patient's body as seen by the endoscope is shown in a circular form or format 810 surrounded by a blank background 812.

In many endoscopic viewing systems, the video screen 805 also displays text corresponding to several operating parameters of the system. Typically, such operating parameters are shown in text on a portion of the screen outside in the background area 812 outside of the central circular image format 810 of the working space 806. As an example, the operating parameters can include the fluid pressure in the working space 806, fluid flow rate into or out of the working space, fluid volume remaining in the fluid source such as a saline bag, the length of time the procedure, fluid intravasation in the patient, and signal or warnings of other operating parameters known in the art.

During a procedure, the physician often will be concentrating on the central circular image 810 to closely observe manipulation of tools in the working space 806. The physician may not see or be able to monitor the text on the side of the video display that is outside the circular image 810 of the working space.

FIG. 18B shows the video display or screen 805 of FIG. 18A and illustrates another aspect of the invention. In this variation, an operating parameter of the system is indicated as a colored region or indicator region 820 adjacent to the circular image 810 of the working space 806. In one variation, the indicator region 820 can be an annular band (or the entire peripheral display area of the screen) of any suitable color such as red, blue, yellow, etc. This annular indicator region 820 will immediately capture the attention of the physician when viewing the working space. The colors used in the indicator region 820 also can be selected to indicate which operating parameter is being highlighted to thereby further inform the physician. Alternatively, the indicator region 820 can have a first color such as yellow to indicate a less significant warning, and a second color such as red to indicate that immediate action by the physician it is required.

FIGS. 19A-19C show another variation of an indicator region 822 were in the width of the indicator region, for example the width W of the annular band, also can vary in width W. FIG. 19A shows the video screen without the in the annular indicator region. FIG. 19B shows the indicator region 822 with a first width W and FIG. 19C shows the annular indicator greater with a second wider width W′. The width also may pulse at a slow interval or a fast interval between different widths to capture the attention of the physician.

FIGS. 20A-20C indicate another variation of an indicator region 824 wherein colored portions of a part annular band are shown which can rotate at various speeds. FIG. 20A shows the endoscopic image without a warning region. FIGS. 20B and 20C show rotation of the part annular colored region 824. In this variation, the colors again can pulse in intensity or switch between different colors and at a slow or fast rate to provide an effective alert to the physician.

Now referring to FIG. 21 , another aspect of the invention relates to optimizing quality of the images displayed on the video display 805 by enhancing the refresh rate on pixels in the video display. In FIG. 21 , it can be seen that the central endoscopic image 840 is surrounded by background 845 within the video display 805, each of which can be defined by the number of pixels on the screen. For example, the central image 840 can comprise 50% of the total pixels on the screen and the background 845 can comprise the remaining 50% of the pixels on the video display 805. In normal operation, the signal processor is capable of a refresh rate across the entire video display, for example, having a refresh rate of 30 Hz, 60 Hz or a multiple thereof. According to an aspect invention, the software that controls image processing and display can be adapted to block any refreshing of the pixels in the background 845 and only refresh the pixels in the central image 840. In this example, the refresh rate then can be effectively doubled which will result in a higher quality image for any given refresh rate of the image processing system.

In general. a method of the invention for enhancing video image quality in an endoscopic viewing system comprising providing an endoscopic viewing system including an image sensor, an image processing system, and a video display having a fixed number of pixels, displaying video images in a circular central portion of the display thereby utilizing a first fraction of the pixels, wherein pixels in a peripheral portion of the display outside the central portion are not utilized, and configuring the image processing system for refreshing the pixels in the central portion and to block refreshing of the pixels in the peripheral portion to thereby enhance the refresh rate of the central portion and improve image quality.

In another aspect of the invention, the image processing system and accelerometers used in orienting and stabilizing an endoscopic image on a video display are adapted to filter out high-frequency vibrations caused by operating components that can affect image signals and the quality of the image on the display. FIG. 22 shows a working end 860 of the tubular cutter or resecting probe 865 of the type known in the art and adapted for insertion through the working channel of the endoscope of the invention (see FIGS. 10-13 ). The resecting probe 865 of FIG. 22 is adapted for detachable coupling to a motor drive handpiece as is known in the art.

In prior art endoscope systems and image processing software, it has been known to filter a user's hand movements from the imaging signals to stabilize and improve image quality. Such hand and finger movements are known to have a maximum repetition rate of movement of 3 Hz. In the present invention, the resecting probe 865 of FIG. 22 and the motor drive coupled thereto will rotate the inner cutting sleeve at rates of 500 RPM to 15,000 RPM. Such high speeds will cause significant vibrations and harmonics thereof that are far higher than movements caused by a user's hand movements. Therefore, it has been found that it is necessary to filter out many specific higher frequencies and/or amplitudes that otherwise would cause noise in the system and thereby provide signal conditioning that would not be needed in typical endoscopes.

Thus, the system and method of the invention includes software algorithms and components that allow for filtering noise vibrations that occur at greater than 3 Hz. The system filters out vibrations or movements of greater than 5 Hz, greater than 10 Hz, or greater than 50 Hz. Such signal conditioning will provide a stable and suitable high quality video image on the video display.

In another aspect of the invention, referring to FIG. 22B, it can be seen that working end has a rotating inner sleeve 866 and inner cutting window 868 that rotates in outer sleeve 870 and outer sleeve cutting window 872 to resect tissue as is known in the art. Such a resection probe is used in a hysteroscopic procedure to resect polyps and fibroids. Such tissue can vary in size and hardness and the resecting probe 865 typically may be adapted to operate at a fixed rotational or oscillating speed, for example, 1,000 RPM, 3,000 RPM 5,000 RPM or more. It has been found that for cutting fibroids of differing hardness, the fixed cutting speed may be relevant to the rate of tissue removal, but it is equally or more important to control the aspiration rate of fluid through the cutting windows 868 and 872 during use. As can be understood conceptually, when the target tissue is soft, such soft tissue is easily suctioned into and captured within the cutting windows. However, dense tissue cannot be suctioned into the cutting windows 868, 872 as effectively which results in a slower rate of tissue removal. Therefore, it has been found that the tissue resection rate can be improved for each hardness of tissue by varying the fluid outflow rate which provides a selected level of suction in the cutting windows. The system thus is configured with a selector for selecting between two or more fluid flow rates. The fluid flow rate for soft tissue apart to low, the fluid flow rate for hard tissues is higher. In one variation, the physician is allowed to select fluid flow rate from 100-250 mL/min for soft tissue, 250-500 mL/min for medium hardness tissues and 500-1,000 mL/min for hard tissues.

Although particular embodiments of the present invention have been described above in detail, it will be understood that this description is merely for purposes of illustration and the above description of the invention is not exhaustive. Specific features of the invention are shown in some drawings and not in others, and this is for convenience only and any feature may be combined with another in accordance with the invention. A number of variations and alternatives will be apparent to one having ordinary skills in the art. Such alternatives and variations are intended to be included within the scope of the claims. Particular features that are presented in dependent claims can be combined and fall within the scope of the invention. The invention also encompasses embodiments as if dependent claims were alternatively written in a multiple dependent claim format with reference to other independent claims.

Other variations are within the spirit of the present invention. Thus, while the invention is susceptible to various modifications and alternative constructions, certain illustrated embodiments thereof are shown in the drawings and have been described above in detail. It should be understood, however, that there is no intention to limit the invention to the specific form or forms disclosed, but on the contrary, the intention is to cover all modifications, alternative constructions, and equivalents falling within the spirit and scope of the invention, as defined in the appended claims.

The use of the terms “a” and “an” and “the” and similar referents in the context of describing the invention (especially in the context of the following claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. The terms “comprising,” “having,” “including,” and “containing” are to be construed as open-ended terms (i.e., meaning “including, but not limited to,”) unless otherwise noted. The term “connected” is to be construed as partly or wholly contained within, attached to, or joined together, even if there is something intervening. Recitation of ranges of values herein are merely intended to serve as a shorthand method of referring individually to each separate value falling within the range, unless otherwise indicated herein, and each separate value is incorporated into the specification as if it were individually recited herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., “such as”) provided herein, is intended merely to better illuminate embodiments of the invention and does not pose a limitation on the scope of the invention unless otherwise claimed. No language in the specification should be construed as indicating any non-claimed element as essential to the practice of the invention.

All references, including publications, patent applications, and patents, cited herein are hereby incorporated by reference to the same extent as if each reference were individually and specifically indicated to be incorporated by reference and were set forth in its entirety herein. 

What is claimed is:
 1. A method for displaying alerts together with images captured by an image sensor on a display device, the method comprising: providing an integrated diagnostic and therapeutic system that includes an imaging sensor, a fluid management system and a controller configured to control operating parameters of the imaging sensor and the fluid management system; displaying images captured by the image sensor as a video in a central circular image of a display device; displaying visual alerts of selected operating parameters provided by the controller in an indicator region of the display device; and pulsing the indicator region at varying time intervals between a first indicator region width and a second indicator region width.
 2. The method of claim 1, wherein the indicator region comprises an annular band around the central circular image.
 3. The method of claim 2, wherein dimensions of the annular band change while the annular band rotates.
 4. The method of claim 3, wherein the annular band has more than one color.
 5. The method of claim 1, wherein the indicator region comprises an at least partial annular band around the central circular image. 